Results from our survey

Our review highlighted that existing telehealth guidelines present considerably variable levels of comprehensiveness, with implementation considerations less explored and having the largest areas of ambiguity. In contrast, technical considerations were more frequently explored and contained more detailed information. Technical considerations are necessary but not alone sufficient (22): successful telehealth consultations require the re-engineering of the clinical processes and an integrated approach to clinical management (23). We acknowledge that some regulatory institutions and professional organisations may have updated or are currently in the process of revising their guidelines, which may provide more comprehensive recommendations than those previously available. We recommend that future telehealth guidelines address all telehealth domains which would prevent guidelines from focusing on hardware and software and, consequently, neglecting people and processes (24), reducing telehealth clinical benefits and creating unintended risks to both patients and AHPs.

Our survey revealed that approximately 40% of NHS AHPs and AHP service managers believed that there was a lack of information within telehealth service guidelines (14). Survey responses confirmed the findings of our review; the most deficient domain of current telehealth guidelines related to implementation considerations. AHPs and AHP service managers also identified areas of ambiguity and a lack of information in the current telehealth guidelines. One example was that many patients with complex needs, associated for example, with their disabilities, age, or language skills, may have been excluded from telehealth consultations or have received care inadequate to meet their needs. In these cases, there is the risk of widening health inequities and the potential telehealth benefits of sustainability, patient empowerment, and the reduction in the burden of treatment may be difficult to obtain (19). Respondents were asked to identify potential barriers to telehealth adoption, with these reported barriers aligning with some of the telehealth considerations currently lacking in telehealth guidelines or requiring further clarification and information.

Regarding training, most clinicians reported that they had not received training in all telehealth aspects. The aspect that most clinicians had received training for was how to use the software required for telehealth consultations. Although this may be attributable to the fact that many AHP services implemented telehealth in a short timescale to ensure continuity of care during the surge of the COVID-19 pandemic, at the time the survey was conducted (more than one year into the pandemic), training was not yet adequately designed, and clinicians reported to lack training in certain telehealth aspects on which education and training were considered as necessary. These aspects included, for example, how to deal with an emergency during a telehealth consultation how to conduct a risk assessment before a telehealth consultation and how to get feedback from patients and their families. Most clinicians did not consider that training was necessary for some other telehealth aspects, such as how to provide a treatment intervention or conduct an assessment via telehealth and how to use the hardware required for telehealth consultations. However, AHP services may have different levels of digital maturity and digital literacy, technology competence and previous telehealth experience may vary greatly from one clinician to another. Therefore, comprehensive training, tailored specifically to meet the needs of the AHP staff of each service, is essential for ensuring a successful long-term implementation of telehealth.